The ANSC GP Resource Manual is intended as a guide for general practitioners participating in the SLHD Antenatal Shared Care Program. The manual content is closely linked with HealthPathways where clinically relevant.

  pdf ANSC GP Resource Manual v 7.4 (9.11 MB)  (June 2017)

GPs participating in the ANSC program will be expected to adhere to the agreed guidelines as outlined in the SLHD ANSC Protocol when caring for their antenatal shared care patients.

  pdf SLHD Antenatal Shared Care Protocol (250 KB)

Breaches of the ANSC Protocol that affect patient outcomes will be recorded for quality assurance purposes. Any investigations requested by the GP for a woman under his/her care must be followed up by the GP concerned. At all times it is the primary responsibility of the provider ordering the test or noting an abnormal finding to ensure appropriate follow-up management and communication, irrespective of whether a copy has been sent to the participating hospital. 

  pdf SLHD Breastfeeding Policy Compliance Procedure 2017 (3.01 MB)  : Comprehensive breastfeeding guidelines and information
 Search for a Certified Lactation Consultant: Lactation Consultants Association of Australia and New Zealand (LCANZ)

Patient information and resources

 SLHD Early Childhood Services
Child and Family Health: all referrals/enquiries to local Early Childhood Centres is via the Central Intake Line (Phone: 9562 5400)

 Australian Breastfeeding Association (ABA)

Infant Feeding Guidelines

 NHMRC Infant Feeding Guidelines - comprehensive guidelines for health workers recommending breastfeeding and infant feeding

All pregnant women should be routinely provided with verbal and written information regarding normal fetal movements during the antenatal period. Clinicans should emphasis the importance of maternal awareness of fetal movements at each clinical visit. Regular enquiry about fetal movements is an important aspect of ascertaining fetal wellbeing.

Women with a concern about decreased fetal movements (DFM) should be advised to contact their health provider immediately. Maternal concern of DFM overrides any definition of DFM based on numbers of fetal movements. 

 Maternity - Decreased fetal movements in the third trimester: Guideline Summary - Ministry of Health NSW
 PSANZ Stillbirth and Neonatal Death Alliance - Resources for both health professionals and women
 Stillbirth- Centre of Research Excellence - Decreased fetal movement resources including clinical guidelines, e- learning module, consumer  video
 Patient Brochure - Pregnancy : Your baby's movements and what they mean  (Available in different languages)

Healthy eating during pregnancy

 NSW Health "Get Healthy in pregnancy" - services including free counselling service,information and resources regarding physical activity, healthy eating and weight gain 
 NSW Health " Get Healthy" Service " - a range of resources developed to assist GPs and AHPs to promote the "Get Healthy" service
 NSW Health " Get Healthy General Practice Referral Form" + additional referral information. The General Practice Referal Form template is already supplied in both Medical Director and Best Practice ( For BP, tick ALL STATES box) 

 Patient Brochure - Healthy eating when you're pregnant or breastfeeding - Department of Health
 Patient Brochure - Food safety during pregnancy - NSW Food Authority

Pregnancy and alcohol

 Women want to know: Discussing pregnancy and alcohol - Department of Health project providing assessment tools and information for health professionals. 

Smoking Cessation Clinics

Drug Health Services offer one-to-one counselling support clinics for individuals wishing to stop smoking. Clinics are located at RPA ph. 9515 7611 (Wed 1.00-4.00pm, Thurs 1.00-4.00pm)  and Croydon Community Health Centre ph. 9378 1306 (Mon 9.00-2.30pm)

Management of Obesity

 RANZCOG College Statement: Management of obesity in pregnancy
 NSW Health "Get Healthy in pregnancy" - services including free counselling service, information and resources regarding physical activity, healthy eating and weight gain

Oral Health

 Patient Brochure- Oral health during pregnancy 

  pdf Diagnostic Testing for Hyperglycaemia in pregnancy (504 KB)  (April 2016) - Includes defining risk, screening protocol, interpreting results, postnatal follow-up and pre-pregnancy assessment
  pdf Glucose Tolerance Test (GTT) Instructions (149 KB)
 ADIPS - Australian Diabetes In Pregnancy Society- Resources for both health professionals and patients

Overdue pregnancies

Following the 40 week GP visit, advise patients to contact the clinic for their post dates appointment.

RPA - Women need to be seen at 41 weeks ⁺¹ day in the Registrars' "Post Dates" clinic. Should this date fall on a weekend the women must be seen in the previous Thursday afternoon.

Canterbury Hospital - Women need to be seen at 40⁺ weeks 

Should they go into labour there is no need to call and cancel the clinic appointment.

Along with routine assessment an internal (P.V.) examination will be attended. A management plan for induction of labour will be determined based on the finding and fully discussed with the woman. Instructions, information and a planned date for their hospital admission will be given.

 Patient Brochure -RPA: Your breech baby 
 Patient Brochure - RPA: Women having an External Cephalic Version (ECV) 
 Patient Brochure -Vaginal Birth After Caesarean (VBAC) Labour Care 
 Patient Brochure - Previous Caesarean 
 Patient Brochure  pdf SLHD Pelvic Pain in pregnancy (259 KB)  

   pdf Nausea and vomiting in preganancy information (70 KB)  - RPA Emergency Department 
   pdf Hyperemesis: Clinical Practice Guideline  (127 KB) - RPA Emergency Department 

Pre-pregnancy counselling is an important and integral part of any woman’s health care if she is planning a pregnancy. It is recognised that situations may require specialist advice including an obstetrician, geneticist or paediatrician.

  pdf RPA Pregnancy Planning Clinic (560 KB)  - multidiscipline service providing comprehensive assessment of preconception health for women and/or couples planning a pregnancy
 Preconception checklist - areas for discussion and referrals (if required) prior to pregnancy

All women, regardless of age should be counselled and offered the option for screening for chromosomal anomalies.

Antenatal Shared Care GPs can refer women directly to the Fetal Medicine Unit (Phone: 9515 6042 or Fax: 9515 6579) for the following tests:

• Combined First Trimester Screening (cFTS)
• Non-Invasive Prenatal Screening (NIPT)
• Chorionic Villus Sampling (CVS)
• Aminocentesis

Relevant referral forms are required to be completed for referral for these tests.

Timing of procedures 

Procedure	Gestation (wks)
Non- Invasive Prenatal Testing (NIPT)	10 weeks onwards
Combined First Trimester Screening (cFTS)	11+1-13+6
Chorionic Villus Sampling (CVS)	11-13
Amniocentesis	15-19

The Fetal Medicine Unit (FMU) at RPA Women and Babies routinely offers Combined First Trimester Screening (cFTS): ultrasound scan (nuchal translucency and nasal bone) plus biochemistry to pregnant women booking for delivery at RPA Women and Babies and Canterbury Hospitals 

Referral for cFTS: 

• Complete FMU Ultrasound Referral Form (yellow)  
• Complete RPAH First Trimester Screening Pathology Form - advise that blood can be collected from 10 weeks until at least 3 days prior  to ultrasound appointment. It should be collected at either RPAH or Canterbury Hospital Pathology Department 
• Provide  First Trimester Screening Patient Information Sheet 
• Provide relevant Patient Information Brochures     pdf cFTS  (285 KB)     pdf NIPT (324 KB)   CVS & Amniocentesis
• Advise woman that her results will be available at time of U/S appointment (ensuring that blood has been collected prior ) 

Access to Non-Invasive Prenatal Testing (NIPT) will be as a second line screening tool for women at high or intermediate level of risk after cFTS. The NIPT test is not available through Medicare and women will have to fund this test themselves. For further information contact the RPA Genetic Counsellors ph 9515 5080 or Fetal Medicine Unit ph 9515 6042

 Resources

  Patient Brochure- Screening tests for your baby in early pregnancy- NSW Health:  Centre for Genetics Education 
  Patient Brochure- Prenatal testing booklet - NSW Health : Centre for Genetics Education
 First Trimester Sceening Learning Module: NSW Centre For Genetics: On-line education module 
Search for Certified Operators to perform Nuchal Translucency - RANZCOG Nuchal Translucency: Ultrasound, education and monitoring program

Translated material regarding genetics, prenatal testing and pregnancy are located at the Multicultural Health Communication Service - NSW Health.

  pdf Thyroid Disease Guidelines (274 KB) : Who to screen, Thyroid Function Test Reference ranges in pregnancy, Referral criteria
  pdf Referral Flowchart - Antenatal Thyroid Clinic
(14 KB)  Thyroid Disease in pregnancy- HealthPathways Sydney

Translated material regarding pregnancy related issues can be located at NSW Health: Multicultural Health Communication Sevice. Information available include maternity care options, planning a pregnancy, caring for a baby at home and depression during pregnancy and early parenthood.

Prevaccination Infomation

• Prevaccination information is available in the The Australian Immunisation Handbook, 10th edition (Section 2.1)
• Prevaccination Checklist
  

Influenza

Vaccination remains the best protection pregnant women and their newborn babies have against influenza. 

Despite influenza vaccination being available free to pregnant women on the National Immunisation Program, vaccination rates remain low with only 1 in 3 pregnant women receiving the influenza vaccine.  Influenza infection during pregnancy can lead to premature delivery and even death in newborns and very young babies. Pregnant women can have the vaccine at any time during pregnancy and they benefit from it all through the year. 

Administration of the influenza vaccination should be at the GP visit and documented on the antenatal "yellow card" next to "Investigations" or circle Y/N if card is stamped with "Flu Vax". The influenza vaccination is available free to pregnant women.

Three educational videos are available:  

For health professionals:

• 2018 Influenza vaccination in pregnancy – Information for Health Care Professionals

For pregnant women:

• 2018 Influenza vaccination in pregnancy – free flu shots 
• 2018 Influenza vaccination in pregnancy – part of good pregnancy care

For further information visit: 
 Immunise Australia Pregnant Women ​
 NSW Health Seasonal Influenza Vaccination 2018
 RANZCOG College Statement: Influenza vaccination during pregnancy
 Influenza Vaccination in Pregnancy and Breastfeeding: Mothersafe factsheets - Patient information

Pertussis

Pertussis vaccination during pregnancy is the best way to protect newborns from day one with studies showing that it is more than 90 per cent effective in preventing whooping cough in infants. Antenatal pertussis vaccination is offered free to all pregnant women and is recommended to be administered in the third trimester (preferably at 28 weeks).

  pdf Antenatal Pertussis Vaccination: GP & AMS Information (46 KB)
  pdf Antenatal Pertussis Vaccination: Evidence Review (573 KB)
  pdf Antenatal Pertussis Vaccination: Consumer Factsheet (503 KB)
  pdf Antenatal Pertussis Vaccination: Consumer Information (A5 pad) (757 KB)
 Immunisation Handbook: Pertussis update
 Protect newborns from whooping cough - NSW Health